Prostatitis Flashcards
Define prostatitis
Inflammation of the prostate gland
Categories of prostatitis
Acute bacterial
Chronic bacterial
Nonbacterial
What is the etiology of acute bacterial prostatitis?
- Ascending urethral infection
- Most common pathogens (Gm-)
-E. Coli (58-88%)
-Proteus, Klebsiella, Serratia, Pseudomonas
STD’s
What is the etiology of chronic bacterial prostatitis?
- Chronic recurrent sx’s w/prostate bacteria
- E. coli (75-80%)
- Enterococci (Proteus, et al),Pseudomonas
- Chlamydia trachomatis
What is the etiology of chronic non- bacterial prostatitis?
- Chronic recurrent sx’s w/ no bacteria
- Cause unknown
3.Theories:
Noninfectious inflammation due to:
-Pelvic muscle spasm
-Ejaculatory duct obstruction
-Autoimmune disorder
What is the most common type of prostatitis?
Chronic non bacterial
How do bacteria infect the body?
Ascent of infection up urethra and reflux into prostatic ducts
Which category of prostatitis is a diagnosis of exclusion?
Nonbacterial prostatitis
What are the sxs of acute bacterial prostatitis?
- Sudden or rapid progression of sx’s-acutely ill
- Fever, chills, malaise, myalgias
- Low back pain
- Perineal pain
- Irritative voiding sx’s:
- Frequency, -decreased stream, -dribbling, -urgency, -dysuria - Hesitancy
- Hematuria
- Cloudy urine
- Exquisite tenderness of prostate
- Enlarged, firm prostate
What are the sxs of chronic bacterial prostatitis?
- Sometimes asymptomatic
- +/- Hx of STD
- Recurrent UTI sx’s
- Irritative voiding sx’s
- +/- Suprapubic pain
- +/- Perineal, testical pain
- +/- Low back pain
- BM Discomfort
- Ejaculation pain +/- blood
- Prostate may feel normal or boggy
- Mildly tender
- +/- enlarged prostate
What are the sxs of chronic prostatitis/chronic pelvic pain syndrome?
- Obstructive sx’s
-Slow stream, hesitancy, dribbling - Pain:
Perineum, low abdomen, testicles, penis, with ejaculation +/- blood - Persistent irritative sx’s:
-Urgency, frequency, nocturia - Nontender or mildly tender prostate
- May be enlarged
- Firm prostate
What are the results of a U/A in Acute bacterial prostatitis?
Pyuria
Bacteriuria
+/- Hematuria: commonly has traces of blood
What are the results of a Ur C&S in Acute bacterial prostatitis?
Identifies pathogen
What are the results of a CBC in Acute bacterial prostatitis?
Leukocytosis
What are the results of PSA in Acute bacterial prostatitis?
Transient increased PSA
What are the results of a U/A in Chronic bacterial prostatitis?
Usually normal
What are the results of a prostatic secretion C & S in Chronic bacterial prostatitis?
Identifies pathogen
Confirms Dx
Rarely done
What are the DS results in nonbacterial prostatitis?
Diagnosis of Exclusion
(-) U/A
(-) UC
Bladder, testicular Sono, CT, etc.
In pt Tx for Acute bacterial prostatitis
- Hospitalization if septic
- IV antibiotics
A. Ciprofloxacin (Cipro) 400 mg IV q 12h + gentamicin
5 mg/kg/d
After pt afebrile for 24-48 hours, change to oral
Cipro 500 mg bid or Levaquin 500 mg qd x 6 weeks
What catheter is preferred for acute bacterial prostatitis?
Urine catheterization is CONTRAINDICATED
Percutaneous catheter is preferred
What is the outpt tx for acute bacterial for men under 35 yrs?
- Ceftriaxone (Rocephin) 250 mg IM + doxycycline 100 mg bid x 10 d or azithromycin (Zithromax) 1 gm po x 1 d
- Ciprofloxacin (Cipro) 500 mg po bid x 4-6 wks
What is the outpt tx for acute bacterial for men over 35 yrs?
Ciprofloxacin (Cipro) 500 mg po bid x 10-14 days
Trimethoprim /sulfamethazole (Bactrim) DS po bid x 10-14 days
Tx for Chronic bacterial prostatitis?
- Ciprofloxacin (Cipro) 500 mg bid x 6 wks or
- Trimethoprim /sulfamethazole (Bactrim) DS 1 po bid x 4-12 wks
or - Azithromax (Zithromax) 500 mg 3x/week x3 wks (Chlamydia)
- Anti-inflammatory agents
- Hot sitz baths
Tx for nonbacterial protatitis?
1.Alpha 14 Blockers + Antibx
Tamsulosin (Flomax) 0.4 mg qd + Ciprofloxacin (Cipro) 500 mg bid x 6 wks
2. NSAIDS
3. Sitz baths
- Refer to Urologist if sx’s persist
Define Orchitis
Acute inflammatory reaction of the testicle secondary to infection (viral or bacterial)
What is the pathophys of mumps orchitis?
Most common etiology. Mumps orchitis follows the development of parotitis by 4-7 days
-20-25% of prepubertal patients with mumps develop orchitis
What is the pathophys of bacterial orchitis?
Bacterial orchitis can be associated with epididymitis or prostatitis
- Occur in sexually active males older than 15 years or in men older than 50 years w/ BPH
- Ascending bacterial infection from urinary tract: Chlamydia, gonorrhea
What pathogens cause the most common form of acute orchitis?
Viral
What are common bacterial pathogens for orchitis?
Neisseria gonorrhea Chlamydia trachomatis Pseudomonas aeruginosa E. coli Klebsiella pneumonia
What complications can occur from orchitis?
Unilateral testicular atrophy occurs in 60% of patients with orchitis
Drop in sperm count 1 in 10 males
What are the symptoms of orchitis?
- Testicular pain and swelling
-Mild discomfort to severe pain - Assoc. systemic sx’s:
Fatigue
Malaise
Myalgias
Fever and chills
Nausea
What are the signs of orchitis?
- Fever
- Testicular swelling & tenderness
- Erythematous & edematous scrotal skin
- Enlarged epididymis associated with epididymo-orchitis
What are the DS: U/A, results in bacterial orchitis?
pyuria & bacteriuria, +/- GC, Chlamydia
Why is a doppler U/S performed in orchitis?
R/O testicular torsion or abscess
What is the tx of orchitis?
- Bed rest
- Hot or cold packs for analgesia
- Support of the scrotum
- Analgesics
- Antibiotics for bacterial orchitis
A.< 35 yr
Ceftriaxone (Rocephin) 250 mg IM + doxycycline 100 mg bid x 10 d
B. 35 yr or >
Ceftriaxone (Rocephin) 250 mg IM + ciprofloxacin (Cipro) 500 mg bid x10d
Define acute epididymitis
Inflammation of epididymis
What is the prevalence of epididymitis?
Incidence is less than 1 case in 1,000 males per year
Common ages 19 – 40 years
Most common cause of intrascrotal inflammation
What is the route of infection in epididymitis?
Urethra ejaculatory duct vas deferens epididymis
What is the pathophys of epididymitis?
- Secondary to trauma
- Causative organism is identified in 80% of patients
- Agent Varies according to the age of the patient
What pathogens cause Epididymitis in prepubertal males?
E. coli
What pathogens cause Epididymitis in sexually active males?
- Chlamydia trachomatis
2. Neisseria gonnorhea
What pathogens cause Epididymitis in elderly males?
- E. coli
2. Pseudomonas
What are the sxs in epididymitis?
- Swelling & pain of scrotum
- May radiate up to ipsilateral flank - +/- Irritative voiding sx’s
- +/-Urinary retention
- Bladder outlet obstruction in older patients - +/- Fever and chills
- +/- Urethral discharge
- Exquisitely tender epididymis
- Erythematous edematous scrotum
What is the Prehn sign and what is it used for?
- Prehn sign is a classic sign of epididymititis
2. Not reliable for distinguishing epididymitis from testicular torsion
What are the U/A results for epididymitis?
Pyuria or bacteriuria (50%)
Who should have a Urine C&S performed for epididymitis?
Prepubertal and elderly patients
What are the urethral gram stain and culture for epididymitis?
Gram (-) intracellular diplococci
What pathogens do you look for in epididymitis?
GC/Chlamydia
Test for syphilis and HIV
When is a CBC ordered in epididymitis?
If patient appears systemically ill or toxic
Leukocytosis with left shift
Why is a doppler ultrasound ordered in epididymitis?
R/O testicular torsion
What is the tx for epididymitis?
- Obtain immediate urologic consultation if unable to clearly differentiate testicular torsion from epididymitis or other scrotal pathology
- Antibiotic therapy
- Analgesics for pain control: generally w/ anti-inflammatory component
- Supportive care
- Scrotal support
- Ice pack
What antibiotics should be used in epididymitis?
- Ciprofloxacin (Cipro) 500 mg bid x 10d
or
Trimethoprim/ sulfamethoxazole Bactrim) DS po bid x 10d - Ceftriaxone 250 mg IM + Doxycycline 100 mg bid x 7d
Neisseria gonnorhea
Chlamydia trachomatis
Define urethritis
Inflammation of urethra
What are common pathogens for urethritis?
- N. gonorrhea
- C. trachomatis
- Mycoplasma genitalium
- Ureaplasma urealyticum
- Trichomonas vaginalis
- “Nongonococcal”
What are the noninfectious causes of urethritis?
Reactive arthritis (Reiter Syndrome)
What are the sxs of urethritis in men?
- Irritative void sx’s
- Dysuria
- Inflamed urethral orifice
- Serous or milky urethral discharge
- +/- blood-tinged
What are the sxs of urethritis in women?
- Irritative voiding sx’s
- Purulent urethral discharge
- Urethral orifice erythema
- Assoc. w/ vaginitis and cervicitis:
GC active during menses
How is urethritis diagnosed?
- Urine C&S
- Gram stain and Culture
- Nucleic acid amplication testing (NAAT):
A. For N. gonorrhea & C. trachomatis
-Endocervical swab
-Vaginal swab
-Urethral swab (men)
-Urine (men & women)
1st urine
What complications can arise from urethritis?
1. Disseminated gonococcal disease A. Septic arthritis B. Conjunctivitis -Purulent -Can rapidly progress to panophthlamitis and loss of the eye unless prompt tx
How is gonococccal urethritis treated?
- Ceftriaxone 250 mg IM + azithromycin (Zithromax) 1 gm po
or
doxycycline 100 mg po bid x 7d
